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Help For Catholic Scrupulosity Problems

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Image_MinichielloI had the pleasure of speaking with Dr. William E. Minichiello, a psychologist at Mass General Hospital, about OCD with Catholic scrupulosity. You can listen to our conversation and read the complete transcript below. Here are the links to the resources he mentioned:

Scrupulous Anonymous

The Paulist Center Boston

Paulist Fathers

– Lee Baer, Ph.D.

Play audio here:

 

You said that you recently saw a woman who was raised Catholic who came to you with scrupulosity concerns about having committed a sin. Do you want to start, without identifying her, by saying what her fear was and then what you told her about what sin is and isn’t?

That was an elderly woman who was referred to me with scrupulosity. She had a lot of doubt about sins, confessions that really weren’t sins. What I explained to her was that in order for something to be seriously sinful, first of all, the matter of what she was concerned about had to be serious matter. That was one thing. The second thing was that she had to know that it was serious. Then the third thing was that she had to have full consent of her will to do that which is serious. Clarifying that for her was very important because she was confessing things that really weren’t sins – they were faults. She never had what we call sufficient reflection. In other words, she never reflected on the fact that she wanted to do that which was seriously sinful. In other words, something that would separate her from God. She never had that reflection. Most importantly, she never had full consent of her will to do that which was seriously sinful, which she knew to be seriously sinful. She was confessing a lot of sins which, as I said, weren’t sins. Certainly nothing that would separate her from the love of God. That was extremely helpful to her, once she got that clear. Her trips to confession became normal rather than what they were. She would go to confession frequently and whenever she went to the liturgy she wouldn’t take part in the most important part, the reception of the Eucharist. That was important to clarify that for her.

Would you say the majority of Catholic priests would agree with the three points that you laid out to her?

I would say the majority of priests should. If they in fact do, I don’t know. The majority of them should be familiar with the principles I laid out. Certainly those who reflected on the teachings of the second Vatican council would be aware of those. I would say they were taught them, whether they carry them out in practice I don’t know, but they should be aware of them.

If someone who’s Catholic has excessive praying or doubts about whether they committed a sin, where would you recommend that they go first for advice in their community?

What they should do to start out with is to find out what they can about an organization called Scrupulous Anonymous, which lays out those principles pretty clearly in its publications. Start there and then go to a parish that’s a progressive parish – where there’s a high probability that the priests would be progressive in their outlook and progressive in their moral teachings. I think that would probably be the best approach.

Let’s say that they’ve been going to a church with their family for years and they haven’t spoken to the priest there yet. Do you think that should be their first step?

If they have a feeling based on having gone to Mass there and based on what they’ve heard in the sermons, they can make a judgment that this is a person with a progressive approach or a black and white approach. If it’s a black and white approach I would suggest that they not and suggest that they go to a place like the Paulist Fathers Chapel in Boston. In most major cities the Paulists have a chapel where they celebrate the liturgy, hear confessions, give lectures, etc. Based on what their assessment is of their local parish from what they’ve heard when they’ve gone there and what they’ve talked to other people in the parish about, if they have a feeling that the priests there are progressive in the spirit of the Second Vatican Council, go there. If not, seek out a place like a Paulist center – if they’re near a large city.

How often have you run into or spoken to priests who you would consider black and white in their thinking and might make the persons scrupulosity worse, or not recognize it as scrupulosity?

It’s certainly less so than it used to be, before the Second Vatican Council. I don’t know if it’s the majority, but a fair number of priests are knowledgeable about scrupulosity and how to handle scrupulous patients.

What’s your impression of the current Pope? If you were to sit down and speak to him about patients you’ve seen who are Catholic who have OCD, do you think he would generally agree with the points that you mentioned? From what you know of his writings and speeches. 

Based on what I’ve seen, he’s terrific. His approach is exactly what’s been needed for so long. He emphasizes the love and mercy of God rather than the aspect of sin and punishment and damnation. His approach is fabulous, and I just hope it continues. He’s emphasizing the right things – he’s emphasizing compassion, love, and forgiveness.

Do you think he would recognize when someone has a problem with doubt, he would separate it being a spiritual problem from being an OCD problem?

I think so. I think his approach is excellent. If every priest in the world adopted his approach I think that would be a major step forward in helping people with religious scrupulosity.

The major ritual or compulsion we see is obsessive praying, or not feeling like the person said the prayer with the right frame of mind. Maybe you could talk about what you’ve seen and what you advise people to do about prayers that can take hours, or they worry all day about whether they’ve prayed correctly.

The important thing there is for people to realize that God knows what’s in their heart and that it’s not necessary for them to repeat prayers. What is prayer – it’s talking to God. You wouldn’t talk to your closest friend and keep repeating the same thing – it would be meaningless. With God, it’s even less necessary to repeat anything because God knows what’s in our heart. The scrupulous person needs to keep that foremost in his or her mind when they pray. They just need to talk to God as if they would talk to their best friend and not continue to go over and over the same thing.

What have you advised patients as far as knowing when to stop or knowing when a prayer is enough?

What I would advise them to do is to start off with what I just said: focus on the fact that God knows what’s in their heart and try and go against what their OCD is telling them to do, which is to repeat what they just said. The goal would be to try and do what someone who doesn’t have OCD with scrupulosity would do, they would say their prayer once and not repeat it. Someone who’s scrupulous, that’s going to be a little difficult, so you try and get them to reduce the number of times they repeat based on how many times they are repeating.  You set a goal, and get them to reduce it each day or each week until they get to the point where they’re like someone who doesn’t have OCD and they just say their prayers once.

How does a person without OCD know when is enough and what’s average length to spend in prayer?

What people who don’t have OCD do, they say their prayer once because they understand and accept that God knows what’s in their heart and it’s not necessary for them to repeat again what’s in their heart. They’ve already done it and God knows what it is. Move on, say it once and that’s it.

Let’s say they can stop repeating but they feel that they have to mention everyone in their family, or is sick, or every friend in their prayer. So even if they don’t repeat it can take hours and hours for them to mention everyone. What advice would you give them?

I’d give them similar advice. So maybe mention everybody once and then after that when they pray they can just say “all those people who I had previously mentioned to you, God. These are the people for whom I’m offering this prayer.” And not go through the list of a hundred people. If they’ve done it once, then they can just make that reference. “God I’ve already told you the people for whom I offer this prayer.”

One of the problems that mental health professionals have in treating people with scrupulosity of whatever religion is they’re not as trained or knowledgeable about the scriptures or the particular religion. Are there New Testament quotes or verses that particularly bother people?

I think there are New Testament verses that would help people not to get into those kinds of things. Some of the verses from John’s gospel about God having loved us, those are important verses to help people. The best approach is getting people to just accept that God loves them and that God knows what’s in their heart. They don’t have to repeat prayers, they don’t have to be afraid that God is waiting for them to make a mistake and that he’s going to hammer them. Try to get them to understand some of the parables that Jesus taught and pointing out how forgiving God is, how accepting God is of our frailties and our sins. The parable of the Prodigal Son, going over that and getting them to understand that in the parable, the father had a big party to celebrate the return of his son, who had gone down to the city and blown his inheritance on riotous and sinful living. When the son had lost everything and wanted to return to his father’s house, the father didn’t make him jump through any hoops. He ordered a big party and sent his other son out to kill the fattened calf and rejoice – the son who he thought was lost had returned.

That’s an example of someone who with intent did something wrong.

People who have OCD, they don’t intend to do those kinds of things. They have all this overwhelming doubt that they did. Doubt doesn’t count. Where there’s doubt there’s no sin.

The last thing I wanted to talk to you about is something that you’ve emphasized talking to me and I don’t think I’ve heard from anybody else. It’s just this idea that the view of the Catholic God as a punishing God seems to have changed a lot since after the Second Vatican Council. I think you’ve said that psychiatrists see a lot less OCD with scrupulosity than they used to. Could you just talk about that change and when it happened and why it happened?

I think that’s one of the encouraging things with Pope Francis. He’s much different than the last two popes who focused on sin and punishment rather than on love and forgiveness. Prior to the Second Vatican Council (1962-1965), that’s what the focus was on and since the Council, the focus has been on love and compassion and not on sin and punishment.

For younger people who weren’t around in the 60’s, what changed in the teaching?

It was a change in focus. The focus went from the negative aspects of religion to the positive aspects of religion. The emphasis shifted away from sin and its consequences and punishment to positive things like compassion, focus on the social gospel; feeding the sick, comforting the grieving, helping the homeless, administering to the poor and the needy. These are the works of mercy as spelled out in the 25th chapter of Mathew’s Gospel. Jesus talks about the last judgment. There’s nothing in there about sexual sins or anything like that. “I was hungry and you gave me to eat, I was naked and you clothed me, I was a stranger and you welcomed me.”, etc. The passage goes on: “When did we see you this way?” and Jesus says: “As long as you did these things for the least of my brothers, you did them for me.” That was the change and emphasis away from sin to ministering to the least of the brothers. The emphasis changed.

That was around the early-mid 60’s?

That was when the council started in 1962 and ended in 1965. Under the next Pope, Paul VI, there was implementation of that. With John Paul II, here was a retrenchment, an effort to get back to the way things were before the Second Vatican Council. I think that has ended now with Pope Francis who is much more like John XXIII who called the Second Vatican Council to reform the church.

Do you think a lot of the differences in advice that a scrupulous Catholic might get would depend on when their priest attended seminary?

I think that’s part of it. But not exactly. You have a lot of young priests who were devotees of Pope John Paul II who are part of that retrenchment. It’s really about how priests responded to the Second Vatican Council and how they’ve tried to implement it at their parish. In different Catholic parishes you’ll see a big difference depending on how the clergy in that parish have responded to the Second Vatican Council.

You mentioned that people should look at Scrupulous Anonymous…

One of the things that they can find there are the 10 commandments of the scrupulous. I think those are extremely helpful. Not to confess doubtful sins when they confess their sins in the Sacrament of Reconciliation, not to repeat sins that have previously been confessed, not to repeat their penance, not to be afraid of looking at a crucifix or a statue because a bad thought enters into their mind. A lot of excellent things are in those 10 commandments.

And their organization is run by knowledgeable, reputable priests and scholars?

It is run by the Congregation of the Redemptorists whose founder, Saint Alphonsus Liguori, also suffered from scrupulosity himself. They’re very reputable and they’ve been at the forefront of helping people with scrupulosity.

The last thing you mentioned was that people can contact the Paulists in their area?

The Paulists are highly educated. They run a lot of the Newman Clubs in the major universities in the United States. In all the major cities in the United States – Boston, New York, Chicago, San Antonio – they have what they call the Paulist Center. It’s like a parish for people who are alienated from their own parish. They have daily Mass, Sunday Mass, confessions, a series of lectures and outreach to carry out the social gospel in the city. To help the poor and so on.

What about people who live in South America or Canada or Europe? Are there Paulist Centers there?

I know there are in certain countries, in Europe and Canada, I don’t know what they have in South America. I know they’re found in some of the European countries.

Any last advice to give to a Catholic who suffers from scrupulosity?

The advice would be that they need to understand that they have a treatable condition and it’s not something that they should continue to suffer with. It’s not something that God wants them to suffer with. God wants them to achieve peace and hope. That’s what Jesus’s message was all about, to bring God’s love and God’s peace and God’s healing and God’s forgiveness to them. There is help out there if they can find the right place to go and the right people to give it to them.

 

 

OCD Scrupulosity: Advice for Fundamental Protestants

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I had the pleasure of meeting Dr. Ted Witzig at the recent International OCD Foundation meeting in Los Angeles, and he kindly agreed to permit me to record a telephone conversation in which I would ask him several of the questions that Protestant OCD sufferers with scrupulosity concerns have asked me over the years. Dr. Witzig brings unique experience both a minister and a clinical psychologist with an expertise in OCD. You listen to our conversation below, and you can also find the complete transcript of our talk below. Dr. Witzig also wanted Christian scrupulosity suffers to be aware of a great deal of useful information he has gathered on his outstanding website.

– Lee Baer, Ph.D. 

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Ted Witzig, Jr., Ph.D. Director of Clinical Services Apostolic Christian Counseling and Family Services 515 E. Highland St., Morton, IL 61550

Ted Witzig, Jr., Ph.D.
Director of Clinical Services
Apostolic Christian Counseling and Family Services
515 E. Highland St., Morton, IL 61550

LEE BAER, Ph.D. (LB):  You’re in a great position by being a psychologist and expert in OCD and also a pastoral authority. One issue is that Protestantism is the greatest range of denominations. If someone who identifies as a Protestant and has scrupulosity, would you suggest that they start by looking for pastoral counseling first?

TED WITZIG, Ph.D. (TW):  Well, it’s really interesting because it’s not that different from other religious groups. The experience that pastors or ministers have with treating people with mental health issues and scrupulosity specifically, varies really widely. The good news is that over time they are becoming more aware that repetitive confessions and people who can’t feel forgiven and feel stuck means that there’s more going on than just a spiritual issue. I really encourage people to have a pastoral person that comes alongside them, but at the same time if that person isn’t familiar with OCD – that’s part of the place that I’m trying to step into is trying to help pastors become educated about OCD and how to work with people. What I’m working on now is in essence a scrupulosity treatment manual from three perspectives so that a client with scrupulosity, a pastoral figure or family member, or a mental health practitioner can all look at this through the lenses of OCD and the person’s faith so that they can reach successful treatment. I find that pastors really need to hear from the mental health practitioners that they’re doing the treatment to improve the person’s faith, not to harm it. I think that historically, particularly in more conservative protestant denominations, there’s been quite a gap between mental health practitioners and clergy, and some suspicion between the two. I try to stand in that bridge, and in many ways it’s just being bilingual and being able to translate those things. Pastors just want to see the person to be well spiritually and emotionally and mental health practitioners want the same. We just need to help them get aligned.

LB:  You say that a person should have a pastoral person along with the team to ensure that there’s no treatment that would go against the church teachings.

TW:  More than anything, I look at the protestant scrupulosity about being around the core of uncertainty, particularly uncertainty about the purity of thoughts, of doubts, of feelings of peace. Oftentimes, they interpret things like uncertainty or doubt as being so spiritually unsafe that it’s a great thing to have a pastoral person be able to look at that person and say “yes, you need to push through that uncertainty.” Having that oomph behind it reinforces the direction of therapy, even if it’s not about getting a specific exposure done, being able to say yes it is the right thing, you need to push through that. It ends up being “moving through the uncertainty is part of your treatment, but it’s also part of faith in general.”

LB: When you tell a patient something like “God understands what’s in your mind and what’s in your heart, and understands that you have a problem” so that if you have a thought that you don’t want to have, God understand that that is caused by the illness – that can be a reassurance, and not helpful. What’s your thought about that?

TW: This is where there sometimes is a departure with people that are schooled in CBT where they want to push “thoughts mean nothing, thoughts of all kinds mean nothing.” Well the problem is that in a lot of Christian circles thoughts can have meaning and do have meaning. So there’s that tension there. What we’re really trying to help people do, is instead of becoming hyper vigilant about thoughts and analyzing thoughts, using thought suppression, all those things, we’re trying to help them learn that the best way to deal with many kinds of thoughts is to let them float and to deal with the uncertainty about that. For example, whether it’s a sexual thought, whether it’s just a regular sexual thought that would happen to anybody, or one that’s intrusive or distressing, I’m going to encourage people to push through those the same way by not spending the time giving the thought meaning and not trying to figure it out. It’s very common for Christians with scrupulosity to try and analyze: was this my flesh, was this a temptation, was this a sin, was this an obsession, and I look at them and say “your job is to not figure it out and to go on.” Ultimately, regardless of what it is, you’re not served by analyzing it. I commonly give an example to people because they’re very doubtful about “did I sin, or did I do this” and a lot of their thoughts are about “what if I, what if I.” They have this sense that they’re going to accidentally miss it. That there’s this gross sin that they’re going to be responsible for that they accidentally missed. And I tell them “If you punched me in the nose right now, gave me a bloody nose, cussed at me, slammed the door and walked out (that’s a horrific scene for the scripture), how long would it be before you realized you’d done something wrong?” and they say “I’d know immediately.” “How about who you needed to apologize?” “Well I’d know immediately.” In that case, you know exactly what you did wrong and who you did wrong to. The issue is that scrupulosity says “well I might have, or what if.” And I tell people that they need to start treating their “what ifs” as obsessions. If you punch me in the nose or if you robbed a bank at gunpoint, you’d know you did something wrong and there wouldn’t be any question. If there’s any question, you need to move on. This whole thing about God knowing our thoughts, I believe it’s true. I think the problem is that people analyzing whether it was a true thought, an obsession, a temptation, that itself becomes a micro obsession. I really encourage people that regardless of what generated the thought they need to not figure it out and go on, and that becomes an exposure.

LB: When you’re saying that, is it as a psychologist or as a pastor? For example, a psychologist wouldn’t say “no, that’s not a sin.” But as a pastor would you say “that’s not a sin” or would you say “that’s OCD.”

TW: When it comes down to whether someone isn’t sure it’s sin, my advice would be that they have to treat it as an obsession. Here’s my pastoral side: I don’t believe that God made a scenario where “there’s one thing, and if you did it you’re done for. But I’m not going to tell you what it is.” What kind of father would I be if I told my daughter “there’s one thing you could do that would cause me to write you out of my will and treat you as dead. I’m not going to tell you what it is, but don’t do it.” And that’s how people with OCD relate to God around their OCD. Particularly with obsessive doubts. The intrusive stuff – thoughts of blasphemy, intrusive sexual thoughts – I find that much easier to deal with than the people who are the chronic ruminators about doubt. If someone comes in with blasphemy, the Holy Spirit, and unpardonable sin, I say let’s get to business. Those chronic ruminators, that’s double heart. It’s doable, but it’s double heart.

LB: A major problem is people worrying that they haven’t prayed properly – they didn’t pray long enough, didn’t have the right concentration, didn’t have the right feelings in their heart, – what advice do you give to them?

TW: I try to figure out what they’re doing lengthwise. One thing I’ve had to do is help people shorten up their prayers because they’re getting to work late and stuff like that. I don’t do what some have done, say “you’re forbidden to pray.” We find an acceptable time range that they need to stay in. In essence, we want them to become functional and within normal limits. If it was 10-15 minutes versus two hours, it’s hard for someone with scrupulosity to say “ten minutes is okay when I was doing two hours?” The other thing is that a lot of people with OCD are searching for that special click. As they play it over in their mind, their mind is searching for that mental coat hook. But they don’t have that coat hook. So I use the imagery of laying the coat down, which means that the purpose of prayer is not about a feeling. I have to work with people about moving their faith away from feelings. And prayer is a big one in that way because they hear people talk about prayer is a time of intimacy, a time where they’re so connected. They end up using prayer as a major checking session or analysis. In Protestantism, repetitions of prayer is not used so it’s pretty easy to say: if you think you said it wrong you’ve got to keep going. Someone who thinks they’re going to pray to Satan might say “In Jesus’ name, in Jesus’ name, in Jesus’ name…” So we use that concept of: what are the things that are normative in the faith community? It’s creating a sense of normalcy. The biggest thing is helping people to detach their emotions and emotional checking from the prayer. That means that prayer may or may not feel right to them. I like to give them “God, help me to accept and move on from obsessions, and help me to fight doing my compulsions.” That’s not the whole prayer, but it’s one of those things that we move it into. Ultimately, it’s about actually getting people to do it, move through it, tolerate that they may not have done it right, and keep going.

LB: What would be an indication for a Protestant with scrupulosity that their treatment isn’t going in the right direction?

TW: One lady at the OC foundation, she came out of a room and she was so panic stricken. She was in a panel talking about exposure. She had thoughts of blasphemy about God – she was saying “F God.” But then her exposure was to sit in church saying “F God” and to eventually being sitting in the front row of church, looking at the pastor, and saying “F God.” Some people would say that’s a great exposure and if she can do that, that’s great.  She said to me: “If that’s what I have to do to get better, I will suffer with this my entire life. I will not do that.” And I said to her: “Ok. First of all, you do need to do some exposure. How about you construct a loop tape that would say something like this: ‘Oh no, I’m sitting in church, and what if I curse God?’” She looks at me, she was pensive for a moment, and said “I could do that. It would be scary.” And I said, “It would be scary, and you need to do that.” There’s not protestant pastor, particularly on the conservative side that’s going to say “Yes, you should sit in the front of church saying F God in your head while I’m doing my sermon.”  The same thing is true with sexual intrusive thoughts. I am amazed at how often pornography is prescribed. I was at a behavior therapy event at the OC Foundation and the suggestion for treating gay thoughts was masturbating to gay porn. You think you’re going to find a conservative protestant preacher who’s going to say that’s a great idea? This kind of stuff creates violations through the person, and they’ll suffer as they do that treatment. I tell people over and over: you have to learn to tolerate uncertainty. You need to be able to come to that place where you don’t have the equations in your head that faith equals uncertainty. But you don’t have to do an exposure where you have to do something that within your faith community would be sinful.

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One of the most common things that people hear – especially if the pastor doesn’t understand that there’s a mental health condition going on – they’ll hear that they have to do it harder. They have to pray harder, they have to read harder, they have to confess harder. If what is being prescribed spiritually gets in that pattern of OCD where you go confess and feel better for a while but feel worse again because you wonder “did I really say the whole thing?” Those kinds of things are definitely something to watch out for. Also, one of the big splits that happens is that pastors tend to see the world through spiritual eyes. Psychiatrists are going to look through biological eyes, some emotional. I tell people that they need to take a bio-psycho-social-spiritual view of their condition. There’s oftentimes this “or” mentality – even among professionals. Pastors and parishioners will hear: “I’m either diligent in my faith or I’m going to take medication. Or because faith didn’t work I’m going to do CBT.” I encourage people to acknowledge the “and” because that’s how God built us. Doing one thing doesn’t diminish the importance of the other.

 

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